Sheila Dinotshe Tlou


I feel it is appropriate that a woman from Sub-Saharan Africa, where millions of people are infected with and affected by HIV/AIDS, should critically examine some of the socio-cultural dimensions of the epidemic.

It is even appropriate because I come from the Southern African Development Community (SADC), the region where more than three quarters of the member countries have the highest number of HIV and AIDS cases in the world per capita. SADC has only 1% of the world’s population, but nearly 40% of the world’s HIV infections are in the region, and the majority of them are young women.

Talking was good: the time for Action is Now

The Platform for Action, resulting from the Fourth World Conference on Women and the Programme of Action,adopted at the International Conference on Population and Development, call for a holistic life cycle approach to women’s health care with emphasis on increased allocation of resources for the provision of affordable health care, health promotion and disease prevention, and prevention and treatment of sexually transmitted diseases and HIV/AIDS.

The call was again made at the 43rd Session of the Commission on the Status of Women when member states resolved to ensure greater protection of women from HIV infection, including access to female controlled methods, access to affordable antiretroviral therapy for people living with HIV and AIDS, eradication of gender based violence and harmful practices such as female genital mutilation. Southern African Development Community (SADC) sponsored a resolution on women, the girl child and HIV/AIDS which called upon Governments, NGOs, civil society and the international community to speed up efforts to prevent and reduce the horrible impact of HIV/AIDS on women and girl children in developing countries.

The twenty-third Special Session of the General Assembly entitled "Women 2000: gender equality development and peace for the twenty first century" noted some positive, but very slow, signs in the fight against HIV/AIDS and member states further resolved to intensify efforts to protect women of all ages from HIV infection and other sexually transmitted infections, including access to female controlled methods, voluntary and confidential HIV testing and counselling, and development of vaccines.

In short, the ‘talk and talk and talk’ about the gender aspects of HIV/AIDS has been with us for a considerable length of time. The question one needs to ask is: why is there so little or inadequate action when it comes to implementing these gender sensitive resolutions?

In my paper I attempt to answer this question by looking at some of the factors behind the non-implementation of these noble resolutions.

Youth: our window of hope

The special vulnerability of girls and young women to HIV/AIDS has been documented in many studies and discussed at the various United Nations fora. While most states agree that young people have the right to develop their capacities, to access a range of services and opportunities, to live, learn and earn a safe and supportive environment, and to participate in decisions and actions that affect them, one finds that social institutions such as schools, NGO’s, the media, the private sector, and the governments are doing very little to support these rights. For example, access to information relating to sexual health is still a controversial issue despite extensive research showing that school-based life skills education empowers youth and does not increase their sexual activity (Kirby et al., 1994).

From my observations, backed by 10 years of experience teenagers who are "kept in the dark" about matters of sexuality are at a much greater risk than those who are provided with information because when they do decide to engage in sex, it is likely to be unsafe sex which immediately results in a pregnancy and/or a sexually transmitted disease. Their ignorance and lack of planning guarantees that they cannot negotiate safer sex let alone carry a condom or even know how to use it.

Girls, women and poverty

In most countries, the legal systems and cultural norms reinforce gender inequality by giving men control over productive resources such as land, through marriage laws that subordinate wives to their husbands, and inheritance customs that make males the principal beneficiaries of family property. This is still happening despite the fact that most of these countries have ratified the Convention on the Elimination of all forms of Discrimination Against Women (CEDAW). Such resolutions have far reaching consequences for the rights of women, the achievement of national development, and the transmission of HIV. Furthermore, Structural Adjustment policies seem to have worsened the levels of poverty in many countries rather than improving their economic situations. As usual, women and girls have been the most affected by some of the strategies employed. The continuing retrenchments and lack of employment opportunities have resulted in women and girls resorting to both direct and indirect commercial sex work for survival, placing them at risk for HIV infection. The appropriate question to ask is: To what extent do governments have linkages between programmes targeting HIV/AIDS at community level to those targeting economic empowerment of women?  Poverty eradication among women requires gendered dimensions by dismantling the institutions and ideologies that maintain women’s subordination in all spheres of their lives. Economic empowerment and poverty reduction cannot be accomplished through anti-poverty programmes alone, but through a democratic environment and changes in economic structures giving access for all to resources and opportunities that enhance their quality of life.

For women living with HIV and AIDS, a gendered approach ensures that they have access to food, sanitation, education, housing and health care, including the provision of antiretroviral drugs. Our governments seem to hide under the cloak of "drugs are too expensive" to the point where very little is being done to procure them, but these are the same governments that spend millions of dollars on military equipment and on armed conflicts. In my own continent, Africa, about one eighth of the military budget of most countries would be enough to provide free antiretroviral drugs to all citizens living with HIV and AIDS, yet it is the drug companies that seem to be getting an unequal share of the blame for exploiting the situation. Whatever happened to state accountability to its citizens?

Political will and commitment

There is still a wide gap between the acknowledgement of HIV/AIDS as a problem and what any one political leader does about it, and the resources to be allocated for such programmes and activities. What we need are leaders who can:

(a) create supportive socio-political and legal frameworks for gender equality.

(b) ensure gender-sensitive programming which educates for use of and provides both male and female-controlled methods of HIV prevention.

(c) transform their societies into ‘noble societies’ which have programmes for the life-long empowerment of women and girl children against HIV/AIDS. One such ‘noble society’ is Botswana which can serve as an example of good governance, political will and commitment to a human rights approach to HIV/AIDS. Some of the national programmes in place include:

    • Free schooling with meals provided
    • Free health care for Tuberculosis and STI clients, persons under 18 and those over 60; the rest pay P2-00 or US 40 cents
    • Universal National Old Age (over 65) pension of P110-00 a month
    • Social welfare programme for the destitute
    • Community home based care programme which includes:
    • (a) food basket for nutrition supplementation

      (b) supplies and equipment such as gloves, adult diapers, detergent, bedpans, wheel chairs, etc.

    • a transportation allowance of P100-00 for volunteer caregivers
    • An orphan programme with supplies and allowances for caregivers
    • An MTCT of HIV programme (AZT and infant formula) for HIV positive pregnant women.

Working with men

Until recently, men have been the almost invisible part of the solution to the HIV/AIDS epidemic even though it was obvious that their socialisation and subsequent behaviours determine how and to whom the virus is transmitted (Panos, 1998). Men, especially African men, tended to be all tarnished with one long brush that painted them as being irresponsible, violent, predatory and fast transmitting the virus. Such labels are very stereotypical, do not facilitate male involvement, and ignore the fact that there are a lot of good, caring, responsible, loving, and very gender-sensitive men in Africa, and they are in the majority. It is only now, after last year’s (2000) World AIDS Day theme, that many stakeholders realise that the qualities of these good men can be tapped and used to role model appropriate behaviours for the "not so good" ones who have wrong perceptions of masculinity.

Civil Society needs to be involved not just as actors but as researchers, decision makers, planners, and designers of programmes on HIV/AIDS prevention and reduction of its impact. Most government programmes fail because they lack community-based experience and expertise, for example: programmes on prevention of mother to child transmission of HIV in Botswana initially had serious problems because they failed to recognise the important role of the community in women’s decisions to go for HIV testing, to take antiretroviral drugs, and to exclusively breastfeed or use infant formula (Tlou, S.D., 2000).

Older persons are important stakeholders because they are increasingly taking on unrecognised, unappreciated, and unremunerated social and economic responsibilities of caring for the sick and for children orphaned by HIV/AIDS at the expense of their own health (Tlou, S.D., 1999). Therefore, HIV/AIDS interventions, including information, education and support, should also target them.

What other steps do we need to take?

Based on the above observations, I would like to reiterate the following recommendations for a global response:

1. We need to emphasise a human rights approach to the HIV/AIDS epidemic which entrenches the principle that governments should be accountable to their people. Each time a woman is unable to negotiate safer sex, it is a violation of her civil rights because it indicates her lack of autonomy to decide on matters relating to her sexual and reproductive health and such a situation cannot continue.

2. There has to be political commitment at the highest level to reform socio-cultural and legal systems to empower women and girls for HIV/AIDS prevention and alleviation of its impact. Heads of state should not just talk about HIV and AIDS, they should rely less on donors and actually allocate at least 10 percent of their budgets for HIV/AIDS programmes.

3. HIV/AIDS is a complex epidemic which requires multipronged solutions. No "single fix" can ever be effective, therefore, I call upon the international community and the relevant United Nations agencies to intensify their support of national efforts against HIV/AIDS prevention for women and girls, especially in the worst hit regions of Africa. Africa needs a sustained, substantial support from the global community or it will be unable to keep pace with the epidemic.

4. Research on gender and HIV/AIDS issues should inform and drive policy, therefore, there should be fora for interaction between researchers, policy makers, and implementers of programmes. The value of policy oriented research and evidence-based practice on HIV/AIDS cannot be overemphasised.

5. Men are not the problem but part of the solution, they are also vulnerable to HIV/AIDS and should be involved in all national and international activities relating to prevention, impact alleviation, and care of people living with HIV and AIDS.

6. Lastly, allow me to speak as an African woman who has lived most of her life in Africa: My fellow Africans, HIV/AIDS challenges us to take responsibility for our own destiny. No one can do it for us. We can solicit and gain the support of the international community, but in the ultimate we have to be the movers and shakers to rid our continent of this scourge. Let us all make efforts to fulfil the obligations of the Universal Declaration on Human Rights and the Africa Charter of Human Rights for "the other half" of our populations, namely the girls and the women.


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